Alleged delayed diagnosis of testicular cancer

The scene

A 40-year old man brought a claim against his GP for an alleged failure to refer him for suspected testicular cancer, resulting in him requiring radiotherapy which would otherwise have been unnecessary.

The patient attended his GP complaining of radiating right loin pain that had not improved. He had attended an out-of-hours service the day before, where he was diagnosed with ureteric colic and prescribed ibuprofen.

The GP examined the patient and noted tenderness over the right renal angle and right iliac fossa, performed a urine dipstick test which revealed evidence of blood and ketones, and then referred the patient to the local hospital's surgical team. Later that day the patient attended A&E reporting similar symptoms. He was diagnosed with suspected renal colic and prescribed paracetamol and ibuprofen.

About three weeks later the patient saw the same GP again, reporting right testicular pain associated with swelling in the scrotum that had been present for two and a half weeks. The patient reported no trauma or risk factors for a sexually transmitted infection and told the GP that scrotal elevation alleviated his symptoms.

The GP performed an examination and was unable to palpate the right epididymis because of the pain felt by the patient. The GP made a suspected diagnosis of epididymitis and prescribed antibiotics, advised the patient to rest and use scrotal support and to return two weeks later if he was no better.

The patient did not seek any medical advice for 18 months, when he then consulted with a different GP reporting a swollen right testicle. The patient was referred for an urgent ultrasound scan of his testis, which reported right sided testicular malignancy. He then underwent a right inguinal orchidectomy and several sessions of radiotherapy.

The claim

The patient instructed solicitors and served court proceedings some three years after the initial consultation with the MDU GP member, alleging that during that consultation the GP incorrectly diagnosed epididymitis and should have attempted transillumination of the patient's scrotal swelling, as well as referring him for an urgent ultrasound scan.

The claim also alleged that if the patient had been referred, the testicular tumour would have been identified and the patient would have avoided radiotherapy and the subsequent side-effects.

One of the MDU's in house solicitors was instructed to represent the member and we obtained independent expert evidence from a GP as well as an oncologist. The GP expert concluded that it was reasonable to diagnose epididymitis and not to request an ultrasound scan, while the oncologist was of the opinion that radiotherapy would not have been needed if an ultrasound scan had been performed as alleged.

The MDU response

In light of the expert evidence, we served a defence denying liability and made an offer for the claim to be discontinued on the basis of each party bearing their own costs, but the patient's solicitors did not accept.

For cases that go to trial, a judge will expect the parties' respective experts to meet beforehand to narrow the issues of dispute that will be considered in court. While there were a number of disagreements between the GP experts in this case, the MDU's team considered that the matter could be successfully defended.

The MDU solicitor therefore sent a robust letter to the patient's solicitors outlining the weaknesses in the patient's case and that we were prepared to defend the case at trial if necessary. The patient discontinued the claim shortly before trial and we were also able to recover our costs. As a mutual organisation this is both important and beneficial for our members.

This guidance was correct at publication 16/07/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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